Volunteer Practitioner Application Thank you for your desire to volunteer with our organization. Please complete the application below and a member of the Siloé team will contact you shortly. God bless!Personal InformationFull Name* Date of Birth* MM slash DD slash YYYY Email Address* Phone Number*Professional InformationTitle / Degree Certification*Your training and professional qualifications Area of Practice / Specialty* Have you ever been dismissed or subject to disciplinary action?* Yes No Explanation*Please explain the disciplinary action you have faced professionally.Attach Your Current License*We are required by Mexican law to keep a copy of all volunteers' medical licenses on file. Drop files here or Select files Accepted file types: pdf, doc, png, jpg, Max. file size: 300 MB. Attach Your CV*Please provide your CV in PDF or Word format. Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 300 MB. Attach ReferencesPlease include at least TWO letters of recommendation. Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 300 MB. Online ProfileProvide a link to your professional website or LinkedIn profile (optional). Volunteering with SiloéSpanish-language fluency*Please select your level of comfort and fluency with Spanish. Fluent / highly capable Conversational Some medical Spanish Minimal / none Would you bring your own translator? Yes No Maybe Have you practiced medicine/dentistry in a foreign country before?* Yes No Describe your previous experience practicing in a foreign countryWhy do you want to volunteer with Siloé?Tell us what motivates and excites you about volunteering with our organization.Trip DetailsDates or Timeframe for Volunteer Trip*Please provide us with either exact dates for your trip or an approximate desired timeframe for serving at our clinic. Will you be traveling with a larger group?(i.e. church group, university, or organization) Yes No What is the name of your group? Accomodations during your trip I'm interested in staying at Siloé I need help booking accommodations offsite I will make my own accommodations / I'm staying with a larger group How many in your group?Siloé has limited housing for short-term volunteers, please let us know how many would require housing.Would you like any meals catered during your stay?If so, please describe how many meals, how many people, and dietary restrictions. We can only offer catered meals for groups of 6 or larger.Medical Missions Policy Agreement*Please be sure to read our medical missions policies (including requested donation information) and agree to them before submitting your application. I have read and agree to the medical missions policies. Δ
